Re: my insurance letter & my friend is going to Dr. K

[Guest guest]

Carole,

I'm glad your insurance company is willing to pay for out of network

services!

Congratulations!

Anita

> Well, I called Med Mutual at 8:45 am (they opened at 8:30 - was I

anxious? oh

> no! Not me!) and was told that what Dawn said was what they meant

with that

> letter. The woman (and I did get her name) told me that this was

just a

> " warning " letter so I would be aware of the fact that they would

not pay 100%

> for out of network, but will pay the percentage my plan states,

which is 70%.

> I am hoping that the $2500 I put upfront covers the difference for

Dr. Hess.

> I called his office again, too and the nurse there told me that

this is a

> normal letter and as long as Dr. Hess gets $5,000 total with my

$2500

> (another $2500 from insurance) that that would be enough. If he

gets less,

> then I will have to pay the difference. I think I am ok on this,

as others

> who had Med Mutual didn't have to come up with any more money for

Dr. Hess.

> However, I have gotten word from others who say he also has an

assistant and

> they had to pay the difference for the assistant. So, I asked

about this,

> too, and Dr. Hess' nurse told me the assistants are either Dr.

Oakley (if he

> isn't doing his own surgery that day), Dr. Hess' daughter, Dr.

Luana Hess,

> or Dr. Albert . I checked Med Mutual and none of those

assistants are

> in their network.

> The good news, though is that Wood County Hospital *is* in network

and

> insurance said they *would* pay 100% for their charges. The letter

only

> names Dr. Oakley (since he is the one I originally saw and the one

who

> submitted the original letter to insurance) as the one they will

not pay 100%

> to.

> So, thank God, this is as I thought it was and I *can* go out of

network,

> they will pay for *some* charges, just not *all*. Hopefully, my

out of

> pocket expenses will be manageable by me.

> I also called the social services office of my state (OH) just out

of

> curiosity to see if they have any provision for me if I am not able

to work

> and not able to collect unemployment while healing from surgery.

I haven't

> gotten a call back yet, but this was suggested to me by someone, so

I thought

> I'd just ask anyway.

> Also - just wanted to let those know who have kids that if you are

not

> working and have dependent children, you can get Medicaide or state

insurance

> usually pretty easily and I think most of them will cover the DS?

Something

> to look into.

> I have a very good friend in California who was the first one to

bring up

> having wls to me and got me started down this road. Well, I found

out about

> DS and told her about it and she was *so glad* because when she

read about

> RNY and Fobi pouch she didn't think she could do it. Well, thanks

to all of

> you, she is going to go to Dr. K in Delano - I told her about him.

And the

> good thing is, she has 2 girls under 18 yrs old so she got on

Medicaide and

> it will pay for the surgery!

> Carole

[Guest guest]

Carole,

This is fantastic news!!! I am so thrilled that it wasn't as bad as

it first appeared! Now, lets just cross our fingers that most of all

the fees for doctor will be covered by your portion that you already

paid!

Hugs,

Theresa

Surgery date: DS Nov. 19, 2001

Dr. Gregg Jossart

Highest weight: 293

Surgery weight: 251

Current weight: 227

Height: 5' 7.5 "

> Well, I called Med Mutual at 8:45 am (they opened at 8:30 - was I

anxious? oh

> no! Not me!) and was told that what Dawn said was what they meant

with that

> letter. The woman (and I did get her name) told me that this was

just a

> " warning " letter so I would be aware of the fact that they would

not pay 100%

> for out of network, but will pay the percentage my plan states,

which is 70%.

> I am hoping that the $2500 I put upfront covers the difference for

Dr. Hess.

> I called his office again, too and the nurse there told me that

this is a

> normal letter and as long as Dr. Hess gets $5,000 total with my

$2500

> (another $2500 from insurance) that that would be enough. If he

gets less,

> then I will have to pay the difference. I think I am ok on this,

as others

> who had Med Mutual didn't have to come up with any more money for

Dr. Hess.

> However, I have gotten word from others who say he also has an

assistant and

> they had to pay the difference for the assistant. So, I asked

about this,

> too, and Dr. Hess' nurse told me the assistants are either Dr.

Oakley (if he

> isn't doing his own surgery that day), Dr. Hess' daughter, Dr.

Luana Hess,

> or Dr. Albert . I checked Med Mutual and none of those

assistants are

> in their network.

> The good news, though is that Wood County Hospital *is* in network

and

> insurance said they *would* pay 100% for their charges. The letter

only

> names Dr. Oakley (since he is the one I originally saw and the one

who

> submitted the original letter to insurance) as the one they will

not pay 100%

> to.

> So, thank God, this is as I thought it was and I *can* go out of

network,

> they will pay for *some* charges, just not *all*. Hopefully, my

out of

> pocket expenses will be manageable by me.

> I also called the social services office of my state (OH) just out

of

> curiosity to see if they have any provision for me if I am not able

to work

> and not able to collect unemployment while healing from surgery.

I haven't

> gotten a call back yet, but this was suggested to me by someone, so

I thought

> I'd just ask anyway.

> Also - just wanted to let those know who have kids that if you are

not

> working and have dependent children, you can get Medicaide or state

insurance

> usually pretty easily and I think most of them will cover the DS?

Something

> to look into.

> I have a very good friend in California who was the first one to

bring up

> having wls to me and got me started down this road. Well, I found

out about

> DS and told her about it and she was *so glad* because when she

read about

> RNY and Fobi pouch she didn't think she could do it. Well, thanks

to all of

> you, she is going to go to Dr. K in Delano - I told her about him.

And the

> good thing is, she has 2 girls under 18 yrs old so she got on

Medicaide and

> it will pay for the surgery!

> Carole

[Guest guest]

I agree with Theresa, Carole - congrats to you!!!

Just think, you're approved!!!!

Hugs,

dee

--- timarie55 wrote:

> Carole,

>

> This is fantastic news!!! I am so thrilled that it

> wasn't as bad as it first appeared! Now, lets just

cross our fingers that most of all the fees for doctor

will be covered by your portion that you already

> paid!

>

> Hugs,

> Theresa

> Surgery date: DS Nov. 19, 2001

> Dr. Gregg Jossart

> Highest weight: 293

> Surgery weight: 251

> Current weight: 227

> Height: 5' 7.5 "

>

> > Well, I called Med Mutual at 8:45 am (they opened

> at 8:30 - was I

> anxious? oh

> > no! Not me!) and was told that what Dawn said was

> what they meant

> with that

> > letter. The woman (and I did get her name) told

> me that this was

> just a

> > " warning " letter so I would be aware of the fact

> that they would

> not pay 100%

> > for out of network, but will pay the percentage my

> plan states,

> which is 70%.

> > I am hoping that the $2500 I put upfront covers

> the difference for

> Dr. Hess.

> > I called his office again, too and the nurse

> there told me that

> this is a

> > normal letter and as long as Dr. Hess gets $5,000

> total with my

> $2500

> > (another $2500 from insurance) that that would be

> enough. If he

> gets less,

> > then I will have to pay the difference. I think I

> am ok on this,

> as others

> > who had Med Mutual didn't have to come up with any

> more money for

> Dr. Hess.

> > However, I have gotten word from others who say he

> also has an

> assistant and

> > they had to pay the difference for the assistant.

> So, I asked

> about this,

> > too, and Dr. Hess' nurse told me the assistants

> are either Dr.

> Oakley (if he

> > isn't doing his own surgery that day), Dr. Hess'

> daughter, Dr.

> Luana Hess,

> > or Dr. Albert . I checked Med Mutual and

> none of those

> assistants are

> > in their network.

> > The good news, though is that Wood County Hospital

> *is* in network

> and

> > insurance said they *would* pay 100% for their

> charges. The letter

> only

> > names Dr. Oakley (since he is the one I originally

> saw and the one

> who

> > submitted the original letter to insurance) as the

> one they will

> not pay 100%

> > to.

> > So, thank God, this is as I thought it was and I

> *can* go out of

> network,

> > they will pay for *some* charges, just not *all*.

> Hopefully, my

> out of

> > pocket expenses will be manageable by me.

> > I also called the social services office of my

> state (OH) just out

> of

> > curiosity to see if they have any provision for me

> if I am not able

> to work

> > and not able to collect unemployment while healing

> from surgery.

> I haven't

> > gotten a call back yet, but this was suggested to

> me by someone, so

> I thought

> > I'd just ask anyway.

> > Also - just wanted to let those know who have kids

> that if you are

> not

> > working and have dependent children, you can get

> Medicaide or state

> insurance

> > usually pretty easily and I think most of them

> will cover the DS?

> Something

> > to look into.

> > I have a very good friend in California who was

> the first one to

> bring up

> > having wls to me and got me started down this

> road. Well, I found

> out about

> > DS and told her about it and she was *so glad*

> because when she

> read about

> > RNY and Fobi pouch she didn't think she could do

> it. Well, thanks

> to all of

> > you, she is going to go to Dr. K in Delano - I

> told her about him.

> And the

> > good thing is, she has 2 girls under 18 yrs old so

> she got on

> Medicaide and

> > it will pay for the surgery!

> > Carole

>

>

>

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>